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Ganglia and cysts on the shoulder - you have to know that

A shoulder surgery service - Orthopedics, Klinikum Dortmund gGmbH

Ganglion /
Cysts
the shoulder

Spinoscapular ganglion: MRI frontal view.

Content:

1. Definition

2. Creation

3. Dates and numbers

4. Complaints

5. Diagnosis

6. Treatment

7. Open or endoscopic surgery

8. Follow-up treatment

9. Forecast

10. Prevention

1. What is a ganglion / cyst on the shoulder? (Definition)
It is a mass on the shoulder, which is mostly behind - on the back surface of the shoulder blade, towards the shoulder joint. Most of the time, these cysts / ganglia are between 1 and 2 cm in diameter.
Such cysts can rarely be found elsewhere in the soft tissues of the shoulder.
A distinction must be made between the degenerative cysts that are frequently encountered in the bones of the humeral head.

Magnetic resonance tomographic cross section of the upper edge of the shoulder socket. The nerve (suprascapularis) and its accompanying vessels run through the cyst / ganglion (white round circles).

2. How does a ganglion / cyst develop on the shoulder? (Etiology)
The exact mechanism by which such a shoulder cyst / spinoscapular ganglion develops is not known. Nowadays it is assumed that a defect / hole - spontaneously with wear and tear on the cartilage lip (labrum degeneration) or traumatic - arises in the posterior shoulder capsule or on the cartilage lip, through which synovial fluid runs into a sac and forms the ganglion.



3. How common is a ganglion / cyst on the shoulder? (Epidemiology)
Spinoscapular ganglia are rare. Some studies describe a frequency of 2 to 4% in a population, although the number is likely to be lower. Men are more likely to be affected, between the ages of 30 and 50.

Arthroscopic view of the interior of a spinoscapular ganglion. The suprascapular nerve is arthroscopically dissected and freed from being pinched by the cyst.

4. What do you notice with a ganglion / cyst on the shoulder? (Symptoms)
Those affected notice a pain in the shoulder, usually without any external reason and spontaneously. It is regularly felt on top of the shoulder or behind.
Such a shoulder ganglion can be accompanied by a weakness when turning the arm outwards.
Local pressure pain is regularly found over the cysts, namely on the back of the shoulder.
A swelling over the ganglion is seldom seen or felt.
If the cyst has existed for a long time and presses on the nerve (suprascapular nerve), a thinning of the muscles on the back of the shoulder (infraspinatus and teres minor muscle) can be seen in individual cases (so-called compression neuropathy of the suprascapular nerve).
Activities at and above shoulder level are regularly painful (throwing movements, cleaning windows, etc.).

Relatively rare: a so-called subcoracoidal ganglion / cyst, i.e. a cyst on the shoulder, in front, under the coracoid.

5. How do you recognize a ganglion / cyst on the shoulder? ( Diagnosis )
The shoulder cysts can be easily visualized by means of ultrasound / sonography.
Another standard procedure for diagnosing spinoscapular ganglia is magnetic resonance imaging of the shoulder. Under certain circumstances, SLAP lesions or damage to the cartilage lip of the shoulder socket can be seen in the shoulder MRI. Magnetic resonance imaging is currently the gold standard in diagnosing these shoulder cysts.

An additional neurological examination and possibly nerve conduction velocity measurement / electromyogram (NLG / EMG) of the suprascapular nerve, which the ganglion can press, can also be helpful.
Under certain circumstances an EMG (electromyogram) can be false negative.
6. How is a ganglion / cyst on the shoulder treated? (Therapy)
The standard therapy for these shoulder cysts is arthroscopic relief. They are found at their insertion, the posterior shoulder capsule, with the arthroscope, opened and mostly decompressed endoscopically.
Depending on the position and extent, it may sometimes be necessary to surgically remove the spinoscapular ganglia on the shoulder using an incision.
Accompanying SLAP lesions or damage to the cartilage lip - such as those that occur in the spinoscapular ganglion in sports such as volleyball - are treated arthroscopically.

Ultrasound right shoulder: large cyst on the back of the shoulder blade.

7. Operate shoulder ganglia / cysts openly or arthroscopically?
Every procedure, whether open or endoscopic, has its advantages and disadvantages.
In open surgery, a ganglion / cyst can be completely removed and the nerve can be inspected. However, the open surgical procedure usually requires relatively large incisions and damage to the cartilage lip is difficult to capture and treat.
With endoscopic surgery, damage to the cartilage lip can be better captured and treated, only small incisions on the shoulder are necessary and the cyst / ganglion can usually be removed at the same time.

Arthroscopic representation and opening of the entrance of a ganglion / cyst on the back of the right shoulder (so-called spinoscapular ganglion).

8. Follow-up treatment / course (rehabilitation)
After the removal, the arm can be actively moved and loaded, depending on the symptoms. Depending on the occupation, the ability to work is achieved after 1 to 6 weeks. Most patients are free of symptoms within a few weeks after arthroscopic decompression - and almost always within the first six months after the operation.

Rare: A ganglion / cyst under the raven's bill process at the front and top of the right shoulder (so-called subcoracoidal ganglion).

9. What is the prognosis of a ganglion / cyst on the shoulder?
If the cysts are cleared, the prognosis is good. They almost always no longer occur after surgical removal.


10. Prevention of a ganglion / cyst on the shoulder:
There are no preventive measures.


Similar terms (synonyms):
Shoulder cyst, spinoscapular ganglion, shoulder ganglion, glenohumeral cyst, glenohumeral cyst, glenohumeral ganglion, paraglenoidal glenohumeral ganglion cyst, ganglion formation, paralabral cyst, paralabral ganglion, spinoglenoidal ganglion, spinoglenoidal entrapmental, spinoglenoidal ganglion

Orthopedics, shoulder consultation, Dortmund Clinic (center), Beurhausstrasse 40,
D-44137 Dortmund, 0231-953-21851